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1.
Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children’s disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.  相似文献   

2.
BackgroundWhen child sexual abuse (CSA) is not disclosed, children run the risk of being subjected to longer or repeated abuse, not receiving necessary treatment, and being re-victimized.ObjectiveThis study examines what adults exposed to child sexual abuse in hindsight evaluate as important for disclosure. The aim was to explore exposed own experiences of steps towards final disclosure.Participants and settingData were obtained from adult users of Norwegian Sexual Abuse Support Centers. Included were users exposed to CSA before the age of 18 (N=23).MethodsData were collected through anonymous questionnaires at each support center. The material was transcribed and analyzed in the tradition of Interpretative Phenomenological Analysis.ResultsThe study illustrates a process towards disclosure as a dialogically anchored process evolving over time and along life-course inside encounters with important others towards whom the exposed pays attention, attunement, and adjustment whether to tell, delay, re-try, turn towards others, or actually disclose. Their experiences elucidate processes towards exploring and telling through direct and indirect hints and signs, decisions to tell, re-decisions and delaying, or withholding until adulthood, and the dependency on trusted confidants who ask and listen for final disclosure to occur.ConclusionThus, the present study sends an important message to exposed, confidants, and professionals when questions of CSA appear. That is to know of, facilitate, trust, and tolerate the dialogical dependency on being asked and heard by trusted persons and the many steps a process towards disclosure of CSA may entail in order to succeed.  相似文献   

3.
BackgroundThe majority of youth with problem sexualized behaviors (PSB) have substantiated experiences of abuse or exposures to violence (Silovsky & Niec, 2002). Little is known about specific abuse experiences that may differentiate youth with PSB from those without. Few studies have examined the types of abuse associated with post-traumatic stress symptomology.ObjectiveThe current study explored two research questions: (1) Do children with PSB differ from children without PSB in terms of their abuse disclosures?; and (2) Are the types of abuse disclosed associated with the child’s scores on a post-traumatic stress measure?.Participants & settingData were analyzed for youth (N = 950) ages 3–18 years who completed a clinical assessment at a child advocacy center in the Midwest during the 2015 calendar year.MethodsYouth completed assessments that included a forensic interview and either the Trauma Symptom Checklist for Young Children (TSCYC) for children ages 3–10 years, or the Trauma Symptom Checklist for Children (TSCC) for children ages 11–16 years. Bivariate logistic regression was used to answer the research questions.ResultsFindings indicated that youths who disclosed offender to victim fondling were less likely to disclose PSB (OR = 0.460, p = .026), and children exposed to pornography were more likely to disclose PSB (OR = 3.252, p = .001). Additionally, youth who disclosed physical abuse (OR = 1.678, p = .001) or victim to offender sexual contact (OR = 2.242, p = .003) had higher odds of clinically significant trauma scores.ConclusionsImplications for practitioners and future research directions are discussed.  相似文献   

4.
BackgroundSchool-based child abuse prevention programs were created to provide knowledge so that children can recognize abuse, teach skills that decrease children’s risk for abuse, normalize the disclosure process, and provide a pathway for children who may be experiencing abuse to report the abuse.ObjectiveThe purpose of this study was to explore school and program factors that trainers in a school-based prevention program believed were associated with disclosure among youth from kindergarten through 12th grade.Participants and settingThis study is based on eighteen trainers and administrators who work with the Play it Safe!® school-based program in Dallas-Fort Worth area.MethodsUsing the qualitative case study method, in-depth interviews were conducted.ResultsData analysis revealed three factors that influenced disclosure: school, school personnel, and program features. The school-related factor was time allotted to the training. The school personnel-related factors were disengagement, ambiguity concerning abuse, prior history with children, and professionals’ personal history of abuse. Finally, the program-related factors were the core messages of the training, providing specific examples, and repetition of the program. To date, there is a dearth of studies that explore the role that schools and school personnel play in the disclosure process.ConclusionChild abuse has devastating effects on children’s physical, social, emotional, and psychological well-being. Understanding more about schools, personnel, and program-related factors that lead to disclosure, which are more amenable to change, is critical to ensuring the safety of children.  相似文献   

5.
ObjectiveFor child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse—teen dating violence link.MethodsA random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales.ResultsOver 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63–67%) and nearly half of males (44–49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings.ConclusionsThese results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others.Practice implicationsThe present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths’ conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare.  相似文献   

6.
ObjectiveThe current study tested several hypotheses about disclosure of childhood sexual, physical, and emotional abuse derived from Betrayal Trauma Theory [Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press]. We predicted that the duration of time from abuse to its disclosure would vary as a function of victim–perpetrator closeness.MethodsData collected from 202 undergraduate participants using a survey methodology were submitted to logistic regression analyses. The relative variance explained by other variables was also examined.ResultsCompared to survivors of emotional abuse (EA) who were in not very close (NVC) victim–perpetrator relationships, EA survivors in very close (VC) victim–perpetrator relationships were significantly more likely to wait 1 or more years to disclose, or never to disclose, than to wait a period of time less than 1 year (OR = 2.65). Further, survivors of physical abuse (PA) in VC victim–perpetrator relationships were significantly more likely to wait 1 or more years to disclose their abuse, if it was disclosed at all, than PA survivors of NVC victim–perpetrator relationships (OR = 3.99). Results for sexual abuse were not significant.ConclusionsFor EA and PA, VC victim–perpetrator relationships predicted longer durations of time from abuse to its disclosure than NVC victim–perpetrator relationships.Practice implicationsAlthough delayed disclosure may support necessary (albeit abusive) attachments with caregivers, it may also prolong the abuse and prevent receipt of support. Increased awareness that VC victim–perpetrator relationships may predict longer durations of time from abuse to its disclosure, and that these delays may serve a functional purpose, can help guide supportive and empathic responses to traumatic disclosures.  相似文献   

7.
8.
BackgroundThere is limited research on the disclosure experiences of men who have experienced childhood sexual abuse and on how such experiences might impact mental health outcomes.ObjectiveThe current study described men’s disclosure experiences and examined the role of disclosure characteristics on mental well-being (internalizing and externalizing behaviors, substance use, resilience).Participants and settingMen (N = 253) from across Canada and the U.S. were recruited through websites for males with sexual abuse histories. Men aged 18–59 years anonymously completed an online study on their sexual abuse, disclosure experiences, and mental health outcomes.ResultsFindings indicated that 77.9% of men disclosed their sexual abuse, although they waited an average of 15.4 years before sharing their experience. Once disclosed, 64.4% of the men reported a positive response (e.g., support), while 35.6% reported a negative response (e.g., blame). Regression analyses indicated that a greater delay in disclosure predicted greater externalizing behaviors (B = .49, p < .05), although this was a small effect (Cohen’s f 2 = 0.02). Additional disclosure variables were associated with components of externalizing (aggressive and rule-breaking behaviors) and internalizing (somatic complaints) behaviors.ConclusionsThese results require replication in future studies. However, they do suggest that efforts need to be undertaken to address the barriers that hinder men from disclosing their sexual abuse and to ensure that men are supported once they disclose.  相似文献   

9.
BackgroundSchool based, peer-to-peer sexual harm is under-researched despite its prevalence and adverse effects on young people across the globe. Understanding barriers to victim disclosure and peer reporting might help towards the prevention and protection of young people.ObjectiveThis study explores dual perspectives of young people and educational staff about school-specific environmental barriers to 1) young people’s disclosure of sexual harm experienced, and 2) young people’s reporting of sexual harm on behalf of others.Participants and setting: Participants include 59 young people aged 13–21 and 58 educational staff, drawn from seven schools across four local authorities in England whom formed part of a wider study on harmful sexual behavior and safety in schools.MethodsFocus groups were carried out with young people and education staff. The sessions were thematically analysed and focused on barriers to disclosure within the school context.ResultsPeer groups set powerful ‘rules’ that influence the ability and willingness of young people to report sexual harm. Some school responses for addressing sexual harm are sub-optimal and sexual harm is not adequately prioritised. Some schools appear to struggle to manage more subtle forms of sexual harm compared with more recognized forms of violence and abuse. A significant proportion of sexual harm is so prevalent that it is ‘normalised’, and therefore under-reported. This resigned acceptance to sexual harm consequently shapes young people’s disclosures.ConclusionsSchool systems of responding to sexual harm require strengthening to increase feelings of safety and empowerment of young people.  相似文献   

10.
Research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates, with males less likely to disclose their abuse compared to females. CSA can have lasting impact on a children’s emotional, physical, and psychological wellbeing. While service providers play an instrumental role in providing care and support for male CSA survivors, little is known about their perceptions and experiences related to disclosure among these men. The aim of this qualitative study was to explore service providers’ perceptions and awareness of disclosure-related barriers and facilitators amongst male CSA survivors. Individual interviews were conducted with eleven service providers. Study findings reveal four key themes related to the disclosure process among male CSA survivors: (a) personal characteristics, (b) interpersonal relations, (c) institutional elements, and (d) societal norms. Findings indicate that service providers understand and respond to complex challenges associated with disclosure of CSA among this marginalized population. Study findings demonstrate the need for additional research on the specific issues of gender bias and stigma associated with male sexual abuse. Along with their empirical significance, these findings can be used to develop more tailored public health and social service-related programming for male CSA survivors, their families, and the broader community to promote a safer and more supportive environment in which to discuss these sensitive and important issues. Recommendations to service providers are discussed.  相似文献   

11.
BackgroundSexual dating violence is highly prevalent within the context of intimate relationships but this form of violence remains understudied among teenagers and emerging adults.ObjectivesTo identify the specific needs of adolescents and emerging adults who reported sexual dating violence, this study aimed to document the: 1) prevalence of sexual DV; 2) perceived social support and help-seeking strategies; 3) facilitating factors and barriers.Participants and settingA total 396 heterosexual youths and emerging adults (aged 14–25) participated in this study focussing on issues associated with romantic and sexual relationships, including experiences of victimization and help-seeking strategies.MethodsThis analysis relied on a mixed methods design. Sexual dating violence in the last 12 months was assessed using an adapted version of the Sexual Experiences Survey (Koss et al., 2007). Semi-structured interviews were conducted with a subsample of 100 youths and emerging adults.ResultsClose to 30% of participants reported having experienced at least one episode of sexual dating violence in the past year. Participants could count on a friend and/or a parent but girls were more likely to seek help compared to boys. Effect sizes were moderate to small. Several barriers were identified, including, having to disclose intimate aspects of their personal life to a stranger.ConclusionGiven ambiguities regarding sexual consent and sexual violence within the context of an intimate relationship, victims expressed reluctance to get formal support. These findings support the relevance of exploring barriers and facilitators to help-seeking to improve access to services for adolescents and emerging adults who report sexual DV.  相似文献   

12.
OBJECTIVE: The present study investigated the context in which children were able to report their child sexual abuse experiences and the children's views as to what made it difficult to talk about abuse and what helped them in the disclosing process. The aim was to study disclosures as they were occurring in their natural settings. METHOD: Data were obtained from therapeutic sessions and follow-up interviews from 20 families with 22 children. These children had said something that made their caregivers concerned about ongoing child sexual abuse. Qualitative analysis was conducted to capture the children's and caregiver's perspectives of the disclosure process. RESULTS: The children felt it was difficult to find situations containing enough privacy and prompts that they could share their experiences. They also were sensitive to others reactions, and whether their disclosures would be misinterpreted. When the children did disclose they did it in situations where the theme of child sexual abuse was in some form addressed or activated. The results indicate that disclosure is a fundamentally dialogical process that becomes less difficult if the children perceive that there is an opportunity to talk, and a purpose for speaking, and a connection has been established to what they are talking about. CONCLUSIONS: It is difficult for children to initiate a conversation about something secret, confusing and distressful, and where there are few conversational routines in a family for talking about such themes. Children also are sensitive to the needs of their caregivers and fear consequences for their family and offender. Children need a supportive structure or scaffold in order to reveal their experiences of child sexual abuse.  相似文献   

13.
IntroductionCoerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences.MethodsThe Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13–24 years in three countries in sub-Saharan Africa.ResultsOver one in ten youth aged 13–24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1–2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1–2.3), physical violence (OR = 2.2, 95%CI: 1.6–3.0), and emotional violence (OR = 2.0, 95%CI: 1.3–2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1–2.0), hurting oneself (OR = 2.0, 95%CI: 1.3–3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1–2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI.ConclusionFSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.  相似文献   

14.
OBJECTIVE: Understanding the impediments that prevented sexually abused adolescents from disclosure to their family or to professionals, and analyzing the responses they received when they did disclose. METHODS: In depth anonymous interviews were conducted in Italy through a toll-free telephone line with 36 young people who experienced sexual abuse in adolescence. A qualitative analysis was carried out of the adolescents' feelings, fears and needs, and of the help received, if any. RESULTS: The main impediments to disclose to a family member were fear of not being believed, shame, and fear of causing trouble to the family. The main impediments for not seeking services were ignorance of the existence/functioning of protective agencies, wish to keep the secret, lack of awareness of being abused, mistrust of adults and professionals, and fear of the consequences of disclosure. When they did disclose to professionals, the teens received very limited support. CONCLUSION: Adolescents need to receive proper information about the risk of being sexually abused and about the help they can receive from their social network and protective agencies. There is a crucial need for appropriate training of professionals.  相似文献   

15.
IntroductionSexual violence (SV) against children is a global health and human rights issue that can have short and long-term consequences for health and wellbeing. Disclosing SV increases the likelihood that children can access health and protective services and receive psychosocial support. Research in high-income countries has found that child SV survivors are more likely to disclose when they are girls/women, experience fewer SV events, and experience SV perpetrated by a stranger. No studies have examined correlates of SV disclosure in Kenya.ObjectiveThe objective of this research was to assess the correlates of disclosing SV among Kenyan youth ages 13–24 who reported an SV experience before age 18.MethodsIn 2010, the Kenya Ministry of Gender, Children and Social Development, the U.S. Centers for Disease Control and Prevention’s (CDC) Division of Violence Prevention, the UNICEF Kenya Country Office, and the Kenya National Bureau of Statistics (KNBS) conducted a national survey of violence against children. These data were used to conduct weighted logistic regression analyses to determine which factors were correlated with reporting SV disclosure.ResultsAmong the 27.8% of girls/women and 14.5% of boys/men who reported SV before age 18, 44.6% of girls/women and 28.2% of boys/men reported to have disclosed the experience. In weighted logistic regression analysis, the odds of disclosure were lower among survivors who were boys/men and among survivors who reported more SV events, and higher when any perpetrator was a family member.ConclusionMore context-specific research on SV disclosure among young people is needed globally.  相似文献   

16.
BackgroundPrevious research has extensively used a socio-ecological perspective to find the correlates of youth involvement in violence. However, little is known about the extent to which ecological factors correlated with youth violence are affected by gender, especially in non-Western cultures.ObjectiveThe role of gender in the association between individual, family, and contextual factors and Arab youth involvement in several types of violence (severe physical, moderate physical, and verbal and indirect violence) was explored using a socio-ecological perspective.Participants and Setting: The study was based on a large random sample of 3,178 Arab students, aged 11–18, from Israel.MethodsInformation was collected from the adolescents through a structured, anonymous self-report questionnaire which they completed in the classroom under the guidance of a research assistant. Confidentiality and anonymity were ensured for all participants.ResultsGender was found to moderate the association between impulsivity and parental support and all types of violence except verbal violence. No interaction effect was found in the association between affiliation with delinquent peers and exposure to community violence and Arab youth involvement in violence.ConclusionsThe results emphasize the importance of exploring gender differences with respect to risk and protective factors for violence. This knowledge is an important step in the design and implementation of gender-specific intervention strategies to deal with youth violence.  相似文献   

17.
BackgroundIdentification, substantiation, prosecution, and treatment of child sexual abuse often rely heavily on a disclosure from the victim in the absence of corroborating evidence. For some, disclosure can be impeded by developmental or motivational barriers, thus compromising child safety and wellbeing. The literature on disclosure prevalence and mitigating influences does not yield a coherent picture. A more accurate estimate will help to inform investigation strategies to facilitate disclosure.ObjectiveThis study provides a meta-analysis of available research examining the prevalence of sexual abuse disclosure in forensic interviews with children under 18 years, and examines a range of factors that may influence the likelihood of disclosure.MethodDatabases were searched for published and unpublished studies up to May 2017. In total, 2393 abstracts were assessed for eligibility, 216 full-text articles were reviewed, and 45 samples (with 31,225 participants) provided estimates of effect sizes.ResultsThe mean prevalence of child sexual abuse disclosure in forensic settings was 64.1% (95% CI: 60.0–68.1). Between-study variability was explained by: (1) child age and gender, with higher prevalence in older children and females; (2) prior disclosure, with higher prevalence when present; and (3) study year, with higher prevalence in more recent studies.ConclusionsThis meta-analysis confirms an upward trend in child sexual abuse disclosure prevalence. However, more than a third of children do not disclose when interviewed, with those who are younger, male, and without a prior disclosure at greatest risk. Important implications for forensic interviewing protocols and future research are discussed.  相似文献   

18.
OBJECTIVE:This research examines the understudied issue of gender differences in disclosure, social reactions, post-abuse coping, and PTSD of adult survivors of child sexual abuse (CSA). METHOD:Data were collected on a cross-sectional convenience sample of 733 college students completing a confidential survey about their demographic characteristics, sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others. RESULTS:Female students reported greater prevalence and severity of CSA, more distress and self-blame immediately post-assault, and greater reliance on coping strategies of withdrawal and trying to forget than male students. Women were more likely to have disclosed their abuse to others, to have received positive reactions, and to report greater PTSD symptom severity, but were no more likely to receive negative reactions upon disclosure than men. Women delaying disclosure had greater PTSD symptom severity, whereas men's symptoms did not vary by timing of disclosure. Additional regression analyses examined predictors of PTSD symptom severity and negative and positive social reactions to abuse disclosures. CONCLUSIONS:Several gender differences were observed in this sample of college students in terms of sexual abuse experiences, psychological symptoms, coping, PTSD, and some aspects of disclosure and social reactions from others.  相似文献   

19.
Three hundred forty-two anonymous surveys regarding unwanted sexual experiences (USE) were filled out in three clinic sites: a pediatric sexual abuse clinic, family practice clinic, and family planning clinic. In the latter two clinics, 40% of females and 16% of males had at least one unwanted sexual experience prior to turning 18 years old. Only 91% of the sexual abuse clinic patients indicated their experience was unwanted. In addition, 27% of the subjects had wanted sexual experiences that were illegal and underreported: These experiences involved a partner at least 4 years older or younger. While feelings of victimization were most common, self-blame and naivete about the abuse were also frequently reported, especially in those who had an USE with a peer. Ambivalence, self-blame, and peer pressure were associated with a lower tendency to disclose one's USE. Although unwanted and illegal sexual experiences were less common in Hispanic females, feelings of self-blame and ambivalence regarding their USE were more frequent in comparison with White females. These findings have important investigative and therapeutic implications for professionals who encounter victims of sexual abuse.  相似文献   

20.
Disclosure of child abuse may enable initiating interventions to end maltreatment and mediate its negative physical and psychological consequences. The present study reviews the field of disclosure and examines factors affecting disclosure among a service population of abused children who were placed in residential care due to various forms of abuse (e.g., physical, sexual, emotional, neglect and witnessing domestic violence). The sample consisted of 286 Israeli (Hebrew and Arabic speaking) children aged 12–17 (mean = 14 ± 1). Following approval of the Ethics committee of the University and parents’ written consent, participants were administered a self-report questionnaire that included the following measures: a Socio-Demographic Questionnaire, the Childhood Trauma Questionnaire (CTQ), the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Results indicated that the three key factors enhancing the likelihood of disclosure were: moral factors, external initiatives and intolerable physical pain. The three key factors inhibiting disclosure were feelings of shame, fear of losing social support and uncertainty as to how and to whom to disclose. Results also showed that children preferred to disclose to their nuclear family members (parents and siblings) in comparison with professionals.  相似文献   

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